Bareback: The Inverse AIDS Crisis

PrEP (pre-exposure prophylaxis) is changing the landscape of gay sex as the inverse of the AIDS crisis. The daily pill, which reduces infection from the HIV virus by up to 90 per cent, is normalizing bareback sex—and leading to a new social pressure to stop using condoms.

Counter to the depictions in Philadelphia, Angels in America, Rent, Dallas Buyers Club and The Normal Heart, the little blue pill has become a new symbol for sexual freedom. Patients on PrEP take a pill (brand name Truvada), once a day, that blocks the HIV virus from entering pathways in the body for men whether they are HIV positive or negative.

Thanks to the protection offered by Truvada, the wave of unprotected sex that drove the AIDS crisis in the 1980s is rising again. Advocacy from the previous generation is reversing the cultural stigma that was bred with the disease’s queer association and bias within the community.

A major motivation for people to use the drug is the fact that it allows them to be protected from HIV while enjoying bareback sex, and apps like Grindr propagate its use as the new normal. The drug’s prevalence within the gay community is indicated by the status option that can be found on pro les, leaving some to wonder about the shift in conversation, where openness to bareback sex now seems to be a prerequisite. Vice contributor Brian Moylan’s 2016 op-ed “Not Being on PrEP Is Making It Harder for Me to Get Laid” resonates with this sentiment, and it’s still relevant in 2018 as the social norms around condom use continue to change.

Of course, medical evidence suggests that PrEP is helping to reduce the transmission of HIV and other sexually transmitted illnesses (STIs). (Healthcare providers require regular HIV testing and STI screenings as part of PrEP treatment as a prevention model.) But many physicians are limited in their ability to prescribe PrEP or offer the education needed, because of a lack of experience with queer sexual health practices.

Although the FDA approved a generic form of Truvada south of the border in June 2017, there’s currently no American federal program to reduce the cost. However, New York City, Los Angeles and San Francisco all provide the medication for free. In Canada, the federal government has approved PrEP as prophylaxis for HIV in general, and residents in Ontario, Quebec and British Columbia (as of January 1) can receive the medication for free as it is covered by most health plans. The Alberta government is conducting a months-long review to assess possible coverage. Other countries, such as England, are still in the midst of their own clinical trials to ensure the drug is safe and effective.

Without coverage, the cost of this drug is staggering, reaching up to $1,000 CAD per month.

For now, the presence of the PrEP has forced us to openly address the taboos on sex within the gay community, as the stigmas of bareback sex have shifted to stigmas around condom use.